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Today on Keynote

(Intro) what's really true is ARS. That's important because if we're not available, reliable, secure, nobody trust this team to talk about anything beyond that.

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare one connection at a time. Our keynote show is designed to share conference level value with you every week.

Now, let's jump right into the episode.

(Main) all right, it's Keynote, and today we are joined by [00:01:00] Myra Davis, the Chief Information and Innovation Officer for Texas Children's Hospitals. Myra, welcome back to the show.

Thank you. Thanks for having me.

I'm looking forward to it. It's been a little while, and I'm sure nothing's new. Texas Children's, actually, to be honest with you, I keep reading stuff.

You guys are on the move. You're doing a lot of things down there. Tell us a little bit about what's going on at Texas Children's.

Yeah technologically, we're doing some really cool work we just opened a hospital in February last year. We did some really innovative solutions there to onboard the more technically savvy patient population that's in Austin.

And then locally we have really been just continuing to move the dial in areas like leveraging data and. Performing more advanced analytics and there I say using AI and bringing in our own internal instance of large language models so we can actually do more. There and really being disruptive with [00:02:00] ourselves and how we can partner with the organization on gaining meaningful insights to the insurmountable amount of data that we have how do we help our organization get smarter, faster?

there's so many directions I want to go with you on, but It's really a privilege to be able to build a new facility. It's not every CIO gets that opportunity, but it's a really. challenging puzzle. It's like you're building something from scratch, you want to make sure it's not going to be obsolete anytime soon.

And so people say things to you like, hey, let's make sure that, you're planning for 10 years down the road. 10 years down the road, I have no idea how to do that anymore in technology. Things are moving so fast. Give us an idea of that journey. No, that's

a really good question because this is the fourth Hospital I've been a part of here at Texas Children's where we build from the ground up.

And as you can imagine we had guiding principles, and we always take guiding principles into every new hospital we build. And it's one don't [00:03:00] deter from the existing infrastructure that you have. To create a meaningful experience for our population, whether it's our families, our patients, and our workforce.

It's really important. Three, try to go with the advanced technology on existing platforms that you have with the goal of fulfilling it, retroing it back into the existing campuses when the time presents itself. And that's usually through. opportunities we have through our refresh investments, our lifecycle investments.

And so those are our biggest pillars if you will of guiding principles. We work very closely with the operational and clinical leaders on experience and what we will take to a new campus. And we also walk through the experience if For some reason, they are traveling around to different campuses.

What would be the difference in experience they would have in an existing campus versus the new [00:04:00] campus? Because that's really important as well. And we do that just to make sure we are. Setting clear expectations of what the new campus will have that existing campuses want. Also making sure, as I said, we don't deter from the infrastructure because at the end of the day, once it's implemented it's typically the same team that now has existing And because we are true to maintaining as close to a highly available and reliable and secure organization, we don't want to stress the existing teams out with new technology that they're unfamiliar with.

So we try really hard to stay true to our existing platforms there as well. so those are the guiding principles that we establish. And then clearly we have financial goals as well. We're always staying within budget. That plays a big role there, but that's how we go about it.

It's interesting.

So you will allow the new hospital to get a [00:05:00] little ahead and set the course for where things are going to go. But the platforms. will inform you're not going to all of a sudden do a new EHR there, obviously. That's the obvious. We

won't do a new EHR, we won't do a new networking system, we won't do a new telecom system, we won't do new devices on floors, like that would be the detriment of disaster and chaos.

So we stick with the existing platforms and systems that we have. We just look to accelerate based on where their roadmaps are. Can we adopt any of that early and then retro through our refresh programs going forward?

So what was the most forward leaning thing that you did there that you're maybe going to have to bring back?

Yeah, a couple of things.

We went with an integrated communication platform called Unified Communication, where we embedded text to messages, phones, alerts, all into one device and barcoding in one device. We don't have that in any existing campus. It's only in our newer campus. And so it afforded us a chance to [00:06:00] iron out all the kinks ensure that it worked.

And then again, through the life cycle refresh strategy, we'll bring it forward the other campuses. The other one is wayfinding. That may sound simple. But we had an opportunity because of the geographic location of that new hospital. In Austin, people can come from all parts of Texas, and so we wanted the ability to really direct them into the right place, the right location, given the right appointment time.

So we created a portal platform that sort of forced them to do that, find their location based off appointments. We also did open scheduling. You don't need a MyChart account. You don't need anything. You just need to come to us. So we opened the scheduling, which was great to say we can do it there.

Why can't we do it in other locations? And we did that with our clinician partners. That was really radical. A big, bold move, but we did it. We've made it. And then we did streaming entertainment there as well. And also the ability to do [00:07:00] bedside bedside care there through monitoring, collaboration with providers and physicians that are at other campuses may need to do a consult given that it's about a four hour drive.

With the local campus in Austin, they have the ability to do it via video streaming. So those are some of the newer technologies that we take there. I'm sure I'm missing out on others, but those were the new ones.

rattled off all those things and none of them are easy, but when you said scheduling the, Hairs on my neck stood up because it just brought back memories of trying to do some of that at St.

Joe's. That's a significant organizational change management initiative, so give me an idea of how that kicked off, like where did the idea originate, and then how did it work its way through?

We had a sort of a strategic steering team, if you will, to talk about going into a new location, establishing a new market.

We wanted to make this as easy for the community as possible. And so we introduced the concept of open versus direct and all the other normal clinics [00:08:00] just for scheduling. And then we talked to the physician leaders there, as well as the operational leaders. And it is a workflow change and it is very, it's a culture change.

But. Because it was, they were onboarding all new physicians, many were new many new employees there. It was easy to pitch the idea and get an adoption because they weren't used to anything else, right? We hired many of our clinical team members came from other locations outside of.

Texas Children's. And so it was really easy to influence them to something new. We had some bumps, I will be honest. We had some shifts and some thoughts about it, but we worked through those together and really created an opportunity to have open. I will say our primary care practices started at first. We had a strategy where primary care practices went to the Austin area first to generate interest, create the brand for Texas children, et cetera, and then specialty care went, and then the hospital [00:09:00] went. Primary care allowed open scheduling for many of their visits. But when you get into specialty care, you have so many visit types.

That was the radical shift in terms of how we would go about open scheduling and it seems to be working really well to where I heard recently that there's some conversations about wanting to do it in some pockets locally. I'm

I remember trying to do that and it was really interesting that you did that with a new population And that makes I think a significant difference in trying to retrofit it.

You hold both eyes innovation and information. Help me to understand how innovation comes to Texas children's, like how does it bubble up and what's your role in that as the chief innovation officer?

I will say I think that word innovation is overused a lot. Because when you just look at the root of it, it just means to change, to make change.

So when it started with my title I went on a listening tour to understand what did innovation mean to many in our organization. And [00:10:00] one of the aha moments was, I think , It initially was defined as something I would do, and that's not, we need to do it.

Not just one person can't really influence that degree of change that would be needed. And so it really drove me to work with the team to create what we have called the innovation hub, if you will. Where we kind of work on a hub and spoke model. The spokes are anybody who has a great idea and we have lots of smart people in this organization and if they have a really cool idea that we're not doing something and we should consider something and explore it, it comes to the hub, which is the innovation team.

And we go through a methodology of defining the problem statement really understanding and exploring, is it really a problem? That's important. And is it a problem that has already been solved? We're a very large system and with 17, 000 people are close to it. And we are education, patient care and research is innovation.

We have a lot of smart people in this organization. So [00:11:00] clearly we want to make sure that's a unique idea, something that we actually should explore. And if we can't explore, and it really turns out to be a problem statement, then we go through a methodology of. Discover, design, and development. The discovery processes, all of it is really agile.

What we discover, how can we solve for this? And it's, we start with, can we leverage something we have? That's the benefit of having the two I's is I'm able to say, wait a minute, Is this something that we can leverage what we have in our existing portfolio of technologies? Is it on a road map of any of our vendors that we partner with today?

And if so, when will it be delivered and can it solve the problem that we're looking at now? And if the answer is yes, then we say let's plan to solve for that by X. Because then it becomes a part of informing how we will adopt the right road map of our existing technologies in the portfolio.

and so then we go into more, if it's not anything, we go into the design phase of designing now, what it could look like. And everything involves people, process, and [00:12:00] technology. And so while the problem statement may list we don't allow problem statements to start with the solution.

Application X. Nope, that's not a problem statement. So there's an iterative process that goes on, and it's not intended to frustrate the individual, but it is intended to articulate exactly what it is that you're trying to solve. Why? Because we need to measure, did we actually solve for it? We need to see KPIs and how we solve for it.

We also need to understand if there's a dependency on a process, or is there a dependency on people competency that is not associated with this problem that nobody thought about. And so once we vet that out, if we don't have all three of those in place and we pause and we stop and we say, okay, we can't solve for this.

We can put tech in, but you're still missing the process and the people part of this. So now we have technology debt. We have technology that's been able, that's not used because we don't have the right people associated with to use it. Or we haven't truly looked at the process. I have a health systems engineering team that is.

certified in black [00:13:00] belts and they do process redesign. And so oftentimes when problem statements come in through the discovery phase, we will ask them to go look at the process as it states now, and what should the process look like later. And then we couple them with the technology team to make sure it complements each other.

We have yet to really look at how we can look at the people side of this and the competency, but that's an opportunity for us as we go forward. But that's how we go about the methodology. If it comes to fruition, then we go into the development phase and then we deliver. A couple of examples that we did this with is with our remote patient monitoring solution.

We also did it with virtual nursing. We went through these phases and it really panned out really well and that we are able to deliver and then allow the operational leaders to determine how they want to scale it going forward. Then they take the path and then. the innovation team is able to release it.

It moves on and they go on to the next opportunity that's in front of us.

That [00:14:00] sounds like an incredibly mature process. And baked into your governance process then, I assume?

It's not, it's baked into the methodology of how the innovation team operates and they work pretty horizontal across the entire IIS team.

The other part of this is, Because I have two eyes, it's really important to me to make sure that the IS team sees themselves as a part of the innovation. You do not want the us against them, or they get to do all the cool things and we get to take care of everything. So the innovation team works hand in hand with the rest of the IS team.

They basically, once they have defined the problem statement, once they've looked at the opportunities and determined They need to determine if we already have that tech in the technology portfolio. They then work with the respective areas in the technology teams, and they identify, hey, I have a problem statement.

I have an opportunity. It doesn't Climb itself to the highest prioritization because really it's an agile. We're trying to explore to see if it's going to solve a problem. So they work hand in hand [00:15:00] with the existing governance structures that already exist. We have not established a new governance structure for them.

We just embed them to the existing governance structure because At the end of the day, innovation is everybody's responsibility, not just the teams, they're just the ones that are fostering those ideas amongst the teams that are looking at day to day tickets and requests and enhancements and project portfolio, et cetera, et cetera.

Does Texas Children's have a three or five year plan That you're working towards, that IT baked into?

Yeah, we have a strategic plan that focuses on three imperatives, which is around being customer obsessed, whether it's with our member population, our family population, our workforce population, our patient population. How do we continue to pay attention to provide the best experience and drive the right quality and safety outcomes? And then we have the other pillar being true financial stewards of what we have and driving to our bottom lines. And then we look at one that's more [00:16:00] horizontally focused, which is around just insightful actions.

How do we look at data? To really true up the how obsessed we need to be on the customer side and it also measures us on the financial performance side. So we look at 3 big pillars and each 1 of them, Bill, there's a list of initiatives that are associated with it. We work with different groups, but IT is an enabler across all of those areas.

Wow. Yeah, and I assume like you probably have more staff and budget than you, have projects coming at you or is it? That's exactly

what it is. Yeah.

That's exactly what it's amazing. All the CIOs I talked to the appetite's insatiable, right?

So healthcare has so many things that it can do and they're all really good. Yeah. They're all, patient facing or they're, they help the clinician to have a better experience and that is one of the challenges. How do you determine what you're going to say yes to?

That's a really good question. Yeah, there's always more in demand than the supply you have, right? But that's what makes our job. I think that's the [00:17:00] fun of it. That's the excitement of it. It's the opportunities that you have in front of you. It's also the excitement for me is to to realize this is a good problem to have.

You should never want a problem where you have all the supply and you have no demand. Think about it, nobody comes to your store and all of a sudden your store shuts down, right? So the excitement part is the creativity around it. There's 3 really important factors in IIS is that we need to ensure that we're always available to this organization, all of our systems.

We need to ensure that they're always reliable, meaning, when I flip the switch on, that light's going to come on every time. That means I need to know when the bulbs need to be changed, et cetera, and that we're always secure. Anybody in the organization will say ARS. That's an IS.

That's what we are responsible for doing. That's about 60 percent of what the supply has to be responsible for. That means zero day vulnerabilities, patch management, upgrades. [00:18:00] break, fix, et cetera. That's what they focus on. The 40 percent is made available to the organization to determine, hey, how do you want to prioritize that net new?

Innovation is a part of that because they consume the same resources that everybody else wants a part of. Having those strategic imperatives that I highlighted before really affords us an opportunity to hone in. On the right projects in partnership with the leaders across the system, as well as the physician community.

Articulating your problem statement, identifying if we can leverage technology we already have, and truly documenting what are the output measures, allow us a scorecard to say, is this the right initiative we should focus on? Clearly, we want to focus on initiatives that drive it. Great performance, increase and enhance the experience, and also drive performance on the bottom line, right?

That's what we want to focus on. And so that's how we triage what comes into the funnel, what will come out of the funnel, and what this remain, the [00:19:00] supply will actually focus on from an initiative standpoint. And there's always something that comes out of the blue and left field. It's not always, exactly the science that I'm highlighting right now.

But we also talk through, do we have the investment of dollars to spend on this? How does it marry itself to existing efforts that we have? Will it create any complications for us going forward? So that work will never stop. But that's the structure. But what's really true is ARS. That's important because if we're not available, reliable, secure, nobody trust this team to talk about anything beyond that.

the basics, the blocking, attacking has to get done. You have

to do it.

Talk to me about your leadership team. So you've been putting them together for quite some time. How did you find the leadership team? What was your? approach to building out the leadership team that you have today?

Yeah. So I've been here 21 years.

I will say the last six years, I've had the best leadership team I've ever had before. You may say what makes that good? It's a highly accountable team, [00:20:00] high standards. They've come from different industries. So what they brought to the table was their expertise in their specific areas.

What they developed and really what brought them here is the mission of this organization. And, the teaser is once you take them on a tour, and they actually see kiddos and women, you got a hook there, right? But the beauty is that this team is a high performance group of leaders, and that's not just the executive team.

That's the team below them as well. High tenured, highly committed. Here organization, we have probably the lowest turnover rate we've ever had despite being in the Texas Medical Center, where, the competition is pretty high, despite being in oil and gas, and many of them have that type of a background they're opting to stay here because of what we do and what we stand for and really, as I said we actually have fun.

And they like to have fun, but they like the challenge as well. And [00:21:00] we're, there's never a dull moment here, and we're 24 by 7, 365, but We all seem to like it for some reason. We like what we do and who we're doing it for. That's what keep us coming back.

so you bring people in from outside the industry to work in a children's hospital.

I found the learning curve in healthcare to be pretty steep, myself, when I came in from outside the industry. The technology pieces are, fairly similar, but the workflow's a lot more complex. The fact that you're, talking to an oncologist is very different than talking to cardiologists.

I had to learn that nuance oh, they don't care about this. They care about this. do you bring them up to speed?

Partnerships really For any of them that come in, we create buddy systems. So they have someone in the team to work side by side.

And then at the onset, we gave them about 90 days to get grounded. And then we list, here's some people we need you to go talk to an interview. And then we just encourage continuation of dialogue and [00:22:00] conversation so that they're learning more about specifically what we do. And in many cases, many of them have kiddos and they are present.

They see their kids are seen here. So they are familiar with. Some areas, but not all areas, but I will also say because we are a learning organization and very collaborative the partners in this, across our system are embracing the leaders that we have and they welcome the opportunity to tell their story, to talk about themselves so that actually works really well.

You brought it up, so I will continue the conversation. You said AI in the first minute of this conversation. And I do want to talk about it. I'm actually going to a meeting tomorrow and we're going to talk about AI in healthcare. \ you presented a very formal process for evaluating these kinds of projects, which AI projects are presenting the most potential for healthcare today?

Wow. The list goes on. I would say notwithstanding that there's AI and automation embedded in pretty much everything. [00:23:00] Every, yeah all the tools we already have, all the tools we already have. The opportunity that's presenting itself is, we've had our enterprise data warehouse.

And so we have over 70 source systems that populated close to nine petabytes of data and that's 70 distinct source systems. Much of the data is structured, but of course, there's unstructured data as well. However what we are starting to realize is that it presents a huge opportunity for my team, the data scientists, the analytic team to work closely with the clinical and operational leaders.

I like to classify as get smarter faster. So what do I mean by that? You look at data like patient experience and. You have to sit through hordes and hordes of data to look at look for signals where we're having providing great experience for patient care and where we have opportunities to enhance the experience.

Imagine being able to sit through key data elements in those [00:24:00] databases and bring to light the patterns of learning that The models have been able to provide and derive and share that information with the leaders across the system, how fast they can act on it. And so we're beginning to explore initiatives like that.

That's one initiative. Another initiative is we collect a lot of information around safety concerns and where potentially we have. Some concerns of safety. It's a huge database. It's a lot of discrete information. How do we bring that information to light signals and patterns and opportunities for our operational leaders to look and make decisions faster?

And so those are a couple of examples that we are currently exploring. There are many more but that's what we decided to do is really go and meet the customers where they are. And talk to them about the possibilities we have with this insurmountable, the amount of data that we have at our fingertips that they may not even be thinking about because they're so focused on [00:25:00] patient care.

the application of AI is really interesting to me. Every system seems to be finding the area that has the risk tolerance that they're looking for. So some of the more advanced ones are going into the clinical side, but some of the others are saying, wait, let's make sure.

let's work with it over here where we can make a few mistakes. And it's not going to cause issues. Not that those other systems aren't. very focused on quality and safety, but they tend to, even within the clinical side, they tend to really put it into a very small walled garden to make sure it's going to do what it's going to do.

recently a governance, an AI governance group comprised of, co led by our general counsel with our executive over data and analytics, and then we have at the table compliance. I think there's representation from finance on there, of course IT and we've also have representation there as well.

So the goal is to obviously look at ensuring that we're not looking at [00:26:00] hallucinations, we're not looking at biases, et cetera as we're continuing to pursue models going forward.

is really changing the world of healthcare pretty dramatically. It sounds like your data warehouse fairly mature at this point, and you have a lot of emphasis on data.

us an idea of, is that taking you, and does that go in the next couple of years?

I actually think that's the insightful actions, insights to create success around the organization. There will be no limits in terms of where we can go and how we can help with, pockets of the organization, get smarter, faster, how we can create efficiencies Where there's clinician maybe performing wash, rinse, repeat processes, how can we make that better for them, whether it's in the radiology sector or the pathology sector? But I just think that data is becoming the new asset for, it is the asset. That's what we need to look at.

And you didn't say data is the new oil in New York and Houston.

I'm surprised you didn't.

No, I have said in the [00:27:00] past, it's it's a pot of gold. But I, for some reason I drew a blank. I didn't say it this time.

It's amazing to me. Every time I go to UGM and I listen to, The different ways that not only the data within individual health systems are being applied, but the data that's being utilized across the larger industry to find patients like, the patient you're treating and those one offs is really fascinating.

And it's the promise that we made when we did meaningful use was, Hey, if we digitize this, we're going to have these benefits. It's taken a lot longer to realize those benefits, but It feels like we're at that tipping point right now.

I think many organizations that have been at it for a while that sit on a significant amount of data, we have a really big opportunity and somewhat an obligation, too, to leverage this pot of gold that we have to make something meaningful of it, right?

Instead of just allowing it to sit and back it up and restore it, we have a huge opportunity.

I'll close with this, you've been in children's [00:28:00] at Texas Children's for quite a number of years. And you'll be there for a little while longer.

How has it changed since you started and how do you think it's going to change over the next couple of years?

I think just from my lens on the digital landscape I was here when it was paper, and now I'm here when it's pretty much all digitized. And it's amazing to me how highly dependent it is.

Thank you. The organization is on the technology. It's fascinating. It's always going to be available. It's always going to be reliable and it sure better always be secure. I think the investments that Texas Children's has made in technology is, that's what's kept me here.

We're clearly wanting to continue to invest. We're continuing to invest and we have invested. I think the dependency on its use we still have opportunities to mature and get better. I don't have a lot of data at it, but I can see what the newer those that are coming on they [00:29:00] know, whether it's new clinicians or new operators or just new people on the teams I definitely see the dependency and need there, and they're wanting it more and again, I can't say enough about data.

Just the ability to leverage the significant asset that, We have to create smarter organization or more faster, give them signals and data points are really important and will be critical for them going forward. I will say the scariest part of this is the cyber side of it. It's unfortunate that We're still under attack.

It's unfortunate that we have to continue to keep our eyes on that target as well. And that enemy when I signed up for this. years ago, that was not on the radar. But now it's like top of mind. It's the first thing I'm constantly thinking about with my team. And we're always focused on it because clearly that one, it only takes one, one time and we're done, right?

[00:30:00] So you can't lose sight of that, unfortunately.

As you were talking about this, it dawned on me that this generation of clinicians that are coming out are digital natives. They grew up on technology from the get go. That's right. So their expectations are probably a lot higher than the previous generation of what technology can do.

But it makes it a little easier because they know exactly what to ask for and what to look for, right? So the more I observe, as I observe that, that transition is not hard for them at all. It's expected. And the more we embrace that, the easier it becomes to explain, maturity of use, to leverage what you have, to look at scalability, things of that nature.

Those conversations are a lot easier, actually, because it's expected from them.

Yeah. Myra, it is always a pleasure to catch up with you. I appreciate it, and I look forward to the next time we get a chance to do this.

Same here. Thank you.

Thank you.

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